Comments on Weight of the Evidence: More Weight Gained Over 6-Years on Low-Fat Diet

I'm a little late on this, but I might suggest that the "unique phenotype" exists in the minority of people who seem to be able to process a high-carb diet *without* accompanying glucose/insulin problems that the rest of us experience to one degree or another.

If true, this diet-phenotype interaction might explain why some of us have to go close to zero carbs to maintain our weight loss, while others can eat between 60 and 100 grams of carbohydrate a day and still maintain.

The almost-zero-carb group might secrete a relatively high level of insulin in response to carbohydrate ingestion, while those who can tolerate more carbs secrete a relatively lower level of insulin.

This would be in line with the observation that animals with their ovaries or testes removed have higher serum insulin. It could explain why our carb tolerance seems to decrease as we get older.

Actually I think the recognition that not everybody responds to a given diet the same way, and the need to individualize prescriptive diets based on metabolic factors is a huge step in the right direction, if it happens.

Please also add to your comments that the mortality observed in this study was actually LOWER than the general mortality in the general population with similar makeup as the ACCORD study. i would be very careful to make assumptions without looking at the trial data first.

Regina, is it possible that this study would allow us low-carbers to present ourselves as a "niche market" in the world of weight-loss diets?

Perhaps we could persuade our doctors to check our insulin concentration at 30 minutes during an oral-glucose-tolerance test as they did in the study. If the findings are correct, we might be able to characterize ourselves as being in a population that responds poorly to high insulin-stimulating diets. That way we wouldn't be threatening an almost religious belief in the idea that a calorie is a calorie, but we could be placed into a special category that requires an unusual type of intervention, i.e., a low-carb type of weight reduction diet.